Abstract
BackgroundProlonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.MethodsSeventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.ResultsThere were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).ConclusionsShortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.Trial registrationClinicalTrail.gov NCT01354249
Highlights
Perioperative care has been the subject of a number of studies in the last decade
Hyperglycaemia is a sensitive marker of the metabolic response to trauma, and it is due to a reduction of the peripheral action of insulin mediated by contra-regulating hormone action
Twenty six patients were eligible for the study and randomized to either control group (CO) group (n = 12) or carbohydrate-protein group (CHO-P) group (n = 14)
Summary
Perioperative care has been the subject of a number of studies in the last decade. The benefits of 6-8 hours of preoperative fasting in order to reduce the risk of pulmonary aspiration of gastric content [1] has been recently questioned by various studies [2,3,4]. These hormones stimulated glycogen and lipid catabolism stimulating hepatic neoglycogenesis as well as increasing peripheral resistance to insulin [7] This response is related to the magnitude of the trauma as well as the duration of preoperative fasting [7,8,9]. Besides IL-6, acute-phase proteins such as C-reactive protein (CRP), and negatives such as albumin and pre-albumin, may be useful as predictors of post-operative infection [8] Within this context, the prognostic inflammatory and nutritional index (PINI) proposed by Ingenbleek and Carpentier has been used and validated to predict risks related to morbidity and mortality. Our hypothesis is that the addition of whey protein to a CHObased drink reduces the inflammatory response and diminish insulin resistance
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